Lauralee Wallace

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT20432 Issued in CA

Practice address

11239 Ball MTN Little Shasta Rd
Montague, CA 96064-9682

Phone

(530) 340-1490

NPI assigned

Oct 20, 2020

Last updated

Oct 20, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, OR2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

University of California, San Francisco School of Medicine, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Well Pelvic Health and Physical Therapy LLC

  • Physical Therapist
  • Yreka, CA
  • NPI 1780459842
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1326647447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11239 BALL MTN LITTLE SHASTA RD",
            "city": "MONTAGUE",
            "state": "CA",
            "postal_code": "960649682",
            "telephone_number": "530-340-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11239 BALL MTN LITTLE SHASTA RD",
            "city": "MONTAGUE",
            "state": "CA",
            "postal_code": "960649682",
            "telephone_number": "530-340-1490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LAURALEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT20432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Leslie
• Little Shasta Elementary School
• Montague Elementary School District
• Road Runner Taxi, LLC
• Roxanne Strangfeld
• Willow Creek Elementary

• Physical Therapist in Montague, CA
• Providers in Montague, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.